2014 National Congress of Family Medicine Residents

Residents Embrace DPC Practice Model, Tackle Student Debt

Charla Allen, M.D., co-author of a resolution asking the AAFP to provide resources on the direct primary care practice model, takes to the microphone during a reference committee hearing on Aug. 8.

Medical residents actively debated a wide range of issues during the 2014 AAFP National Congress of Family Medicine Residents here Aug. 7-9, including enhancing education about the direct primary care (DPC) model of practice, relieving medical school debt and increasing support for rural medicine were among the major issues residents addressed. The congress met during this year's National Conference of Family Medicine Residents and Medical Students.

Direct Primary Care

Perhaps with an eye to the day when they'll be hanging up their own shingles, residents strongly supported the need for educational resources related to DPC, adopting a resolution that calls on the AAFP to "explore the establishment of curricular experiences in the direct primary care practice setting for residents and medical students."

A second resolve clause calls for the Academy to investigate the establishment of residency programs sponsored by DPC practices that would be self-funded, thus providing an option to increase available residency positions that would not require federal legislation.

Story highlights

Residents adopted resolutions asking the AAFP to provide information about direct primary care during the 2014 National Congress of Family Medicine Residents.

Mounting student debt was another priority that residents called on the Academy to address.

Residents also expressed grave concern about a new licensing pathway that would allow medical school graduates to practice as "assistant physicians" in Missouri.

"(DPC is) always compared to concierge medicine, but it's much different," said the resolution's author Phil Eskew, D.O., of Heart of Lancaster Regional Medical Center in Lititz, Pa. "The cost is very low, and it often helps people who are uninsured."

The congress also adopted two related measures, one of which asks the AAFP to create a DPC toolkit specific to family medicine residents who wish to establish a DPC practice right out of residency, as well as regional workshops on starting, rather than transitioning to, a DPC practice. The second measure asks the Academy to provide other educational resources on the topic, including seminars at the 2015 National Conference.

"As residents, the training we get in business models in general varies from program to program," said Charla Allen, M.D., of Texas Tech Family Medicine at Lubbock, a co-author of both resolutions. "We believe a toolkit that would help residents coming out of residency would be very beneficial."

Student Loan Debt

Educational indebtedness among medical school graduates has been climbing steadily during the past two decades, and several measures residents considered addressed lowering the debt burden. They eventually adopted a substitute measure that combined these resolutions and calls for the AAFP to oppose any cap on loan balances that are part of the Public Service Loan Forgiveness Program for primary care.

Enactment of legislation that allows medical school graduates in Missouri to practice primary care without accredited residency training sets a dangerous precedent for other states, Jennifer Allen, M.D., testifies during an Aug. 8 reference committee hearing.

A second resolve of that substitute measure asks the AAFP to "encourage lowering Graduate Direct Loan interest rates to levels at or below 4 percent." Residents who supported the measures contended during reference committee testimony that students are less likely to default on their loans than people who purchase homes at a lower interest rate.

"If you can get 3 percent on a mortgage but you can only get 8 percent on a student loan, then there's something wrong with that," said Jason Woloski, M.D., of the Penn State Hershey Medical Center Family Medicine Residency in Hershey, Pa., author of one of the original resolutions.

Some testimony focused on tying the interest rate for student loans to the prime rate, but others noted that figure could fluctuate substantially.

"Right now, interest rates are low," said Tanna Albin, M.D., of St Vincent Family Medicine Residency in Jacksonville, Fla. But, she added, "The prime interest rate could go up to 6 percent."

Jason Woloski, M.D., testifies Aug. 8 on a resolution calling for routine patient counseling on the availability of parenting classes.

Residents Support Parenting Classes

In a sign that residents are aware of their expansive role as comprehensive caregivers, the 2014 National Congress of Family Medicine Residents adopted a resolution urging the AAFP to recommend routine patient counseling about the availability and benefits of parenting classes for first-time parents or primary caregivers.

"Improved parenting will help limit adverse events," said resolution author Jason Woloski, M.D., of the Penn State Hershey Medical Center Family Medicine Residency in Hershey, Pa. "We need to remove the stigmas and ensure that parenting classes are available to everyone."

Rural and Global Training

Several residents introduced resolutions that addressed residency training in rural and other medically underserved areas. The congress adopted one measure that calls for the AAFP and other family medicine organizations to identify and disseminate information about the best ways to provide financial support to programs that send residents to rural or international sites for training. However, a measure calling for the AAFP to finance rural training consultants through Residency Program Solutions was not adopted because the measure did not provide enough information about how any such subsidy would be used.

Competition for residency slots is intense, and many qualified graduates are left without a match. Legislation recently enacted in Missouri allows medical school graduates who have not matched into a residency program to work as "assistant physicians" in the state's medically underserved areas with a physician's supervision.

Although the legislation is intended to increase access to primary care, residents at the meeting were concerned that graduating medical students are not prepared for patient care and adopted a resolution that calls for the Academy to develop a policy statement opposing special licensing pathways that are not associated with accredited U.S. postgraduate medical training programs.

"Medical school graduates are not prepared to practice medicine," resolution co-author Jennifer Allen, M.D., of Mercy Family Medicine Residency-St Johns in St. Louis, Mo., told AAFP News. "They are trained to be residents."

The problem of inadequate numbers of primary care residency positions should be addressed head-on, Allen contended, "We need to create more residency slots," she said. "We don't need to create a new licensing pathway."

Other Issues

Other resolutions residents adopted call for the AAFP to

support any congressional action to ensure employees' access to essential health benefits, including contraception and oppose measures that shift the cost of contraception to insurers;

develop a global health website linked to the AAFP home page that emphasizes family medicine as an ideal specialty for global health;

work with the Society of Teachers of Family Medicine and other organizations to establish best practices in tracking patient encounters; and

sign on to the AllTrials campaign, which calls for registering data and reporting results of all clinical trials.